When American Airlines 341 flight to Los Angeles was lifted off the runway at New York’s John F. Kennedy Airport on a cloudy Thursday in mid-March, most of the country had been locked up by a coronavirus. The flight was far from full, but 49 passengers and eight crew shared small rooms, cabin air and narrow passages for a six-hour trip.

Although no one knew then, a man in his first class, a retired Manhattan surgeon, was infected with the virus. The day after the flight, he was rushed by ambulance to Cedars-Sinai Medical Center with high fever and cough with phlegm. The virus spread quickly among people he had contacted within hours of leaving LAX, including in a facility assisted by Westside where a 32-year-old nurse and a dozen others later died.

LA. still in the early stages of a COVID-19 pandemic when surgeon flights landed, with fewer than 250 confirmed cases. Local health officials regularly assured the community at the time that the district was investigating each case and was involved in aggressive contact tracing to control the spread of the virus.

Despite these promises, no one in the public health field told anyone passengers and crew who flew across the country with surgeons that they were at risk. The airline recently learned about this case from The Times.

It was one of two long-haul flights to LAX in March identified by The Times where public health officials failed to warn passengers and crew who had flown in with someone who was later tested. COVID-positive. On another, March 8 flight from Seoul, the stricken passenger reported having a fever for days before boarding the plane and going to cardiac arrest the morning after he landed, becoming the first confirmed COVID-19 death in region A.

Without instructions to quarantine themselves or seek testing, more than 200 people on this flight returned to their families and communities who were unaware of their exposure, which could potentially transmit new outbreaks.

“My God,” said Dr. George Rutherford, previously a state epidemiologist for California, after hearing that passengers and crew were not contacted. “That’s a problem.”

Incorrect handling of these cases raises questions about how well public officials have been tracking contacts so far and whether they are ready for the expected uptick in the case when California reopens. The country currently has more than 140,000 confirmed COVID-19 cases.

Tracking sick passengers can be an easier process than investigating infected grocery store clerks or health workers who may have made contact with hundreds of foreigners. The airline maintains a detailed passenger list, seat assignments, and contact information, and the U.S. The Centers for Disease Control and Prevention has a well-established system to help the local health department obtain information and notify passengers seated near infected people.

A CDC spokesman said his records showed that in the LAX case, public health officer A. never told the agent about the flight so contact tracing could begin.

“Any delay in contacting people who are exposed will increase the likelihood of spreading the disease,” said a CDC spokesman.

The district health department said officials told the CDC office at LAX about South Korean flights. In the case of JFK flights, contact tracers closed the case after they were unable to contact the surgeon for an interview. The department currently has more than 1,500 contact tracers and plans to add more if cases increase.

“In March, whenever Public Health was aware that someone traveling with an airline that could potentially transmit COVID-19, he notified the CDC,” the department said in a statement to The Times..

Asiana Airlines Flight 202 departed from Seoul for LAX on March 8 carrying 154 passengers, including a 68-year-old from Florida and her husband.

Woman returning from a visit to the Philippines, and in his last days there, he complained that he felt unwell and had a fever. By the time he boarded a connecting flight in South Korea, it seemed lost because he passed the temperature check at the airport, according to his daughter, who requested that her mother’s name and name not be used for fear of being harassed.

After almost 11 hour flight, the woman went to a relative’s house in Walnut. The next morning, he stopped breathing. He died March 10, the first COVID-19 death confirmed in L.A. County Almost immediately, a representative of the public health department contacted his daughter to help reconstruct the mother’s last interaction. At the time of his death, there were only 17 known cases in the area.

“I feel this urgency,” his daughter recalled. “I talk on the phone every day with them for a week.”

The health department tracked down the man who picked up the woman and her husband from LAX, a relative’s relatives. His daughter said that he was later told to the driver, whose name he did not know, had died of COVID-19. Public health officials declined to provide details about their investigation, citing patient privacy.

Contact tracker asks for partner’s flight number and even asked for the assignment of his chair. But no health authority contacted Asiana Airlines to get the manifest of the flight or the Korean CDC partner, said a spokeswoman for both.

In the United States, the agents in charge seem to blame each other. A CDC spokesman said, “This flight is not in our contact inquiry database, and the CDC did not receive questions about this flight.” The district health department kept officials “informed of the CDC Quarantine Station at LAX according to protocol for potential follow-up.” The Times requested documentation of the notice. Regency does not provide.

A few months after the Florida woman’s death, her daughter was still thinking about other passengers on flights from Seoul. He asked his father recently whether his mother was wearing a mask. Most of the time, he said.

“I’m just worried about other people who might be infected. You feel all these mistakes, “he said.

Because the risk of infection is a function of closeness and length of exposure, air travelers are vulnerable to COVID-19 from fellow passengers, said epidemiologist David Engelthaler.

“Sitting in a closed environment for a long time only increases overall exposure,” said Engelthaler, head of the infectious disease group of the Arizona Translational Genomics Research Institute.

When a passenger travels when infected with a novel coronavirus, the CDC protocol is to notify those who sit within a six foot radius. Depending on the configuration, it can mean passengers in the same line together with two lines in front and two lines in the back.

But some scientists have criticized this standard as inadequate and potentially dangerous. One 2016 study found that for SARS and influenza, about half of those infected with the virus sat more than two rows away from infected people. On a three-hour flight from Hong Kong to Beijing in 2003, for example, a passenger with SARS infected two flight attendants and eighteen other passengers scattered throughout the aircraft.

In the case of LAX flights, “I will tell everyone on the flight that they have been exposed,” said Rutherford, a professor of epidemiology at UCSF. “We will encourage them to be tested, and we will investigate the people who sit closest … and make sure they are tested. “

Other jurisdictions have received broader warnings. When a passenger on a two-hour flight to Rochester, N.Y., from JFK got off with COVID-19 in mid-March, public health officials there made public announcement that everyone who boarded and whoever was at the airport at the time had to be aware of the symptoms.

At the beginning of the pandemic, public health officials were very focused on the airport because they were trying to control the virus. The first known case in L.A was detected January 22 at LAX. A man from Wuhan, China, who was connected through the airport with his family on his way home from a Mexican vacation told the Customs and Border Patrol agent he needed medical treatment and was then taken to a local hospital and diagnosed with a virus. Public health officials notify passengers who sit in two rows of infected people and instruct the airline to contact the crew. Men from Wuhan have finally recovered.

Since the pandemic began in the U.S., the CDC has facilitated 392 air travelers investigative tracking contacts. The agent refused to provide further details, and it was not clear if there were other flights that were not reported other than those identified by The Times.

When the surgeon ‘s flight landed on the night of March 19, the number of cases in L.A. County has reached 200, but the county still tells the public that it is capable of carrying out adequate searches.

“All confirmed cases are being isolated and close contacts are quarantined,” the area said in a press release later that day.

The 69-year-old surgeon flew to LA. so he can move to Silverado Beverly Place, the dementia care residence on the edge of the Fairfax district. His relatives did not return phone calls to ask for comments. The surgeon was the subject of trusteeship in February, and The Times did not mention his name because his mental competence was unclear.

Just before the flight, he was discharged from New York City hospital, according to a correspondence from Silverado and an interview. At that time, coronavirus spread rapidly in the city, including in medical facilities.

There was little effort to quarantine him from other residents as soon as he arrived at Silverado from the airport, according to three employees who remembered him having dinner at another resident’s company shortly after his arrival.

The nurse assigned to greet him, Brittany Bruner-Ringo, later told her mother, sister and colleague that the man had a fever and cough when he arrived. Silverado denied this and said medical records prepared by nurses showed he had no symptoms.

However, the following day, the doctor was clearly unwell with a temperature of 101.9 and “productive cough,” according to medical records. An employee who spoke on condition of anonymity because he was not authorized to speak in public said when he told him he needed to stay in his room because of a pandemic, he replied, “Yes, I know the situation. And I was really hot and had it, and I had to go to the hospital. ”

Taken to Cedars-Sinai, he was tested positive for COVID-19.

Passengers and crew on flights from New York are clear targets for contact tracing, but no one is trying to contact them. The district health department said it had not studied the surgeon’s positive test for 11 days, and at the time, “contact information provided for individuals was incomplete and investigators were unable to conduct interviews.” District officially closed the case after 14 days.

It is not clear why contact tracers will not turn to Silverado for information about surgeons. The facility submitted a report to the county within hours of testing positive, giving the sick man’s name, explaining his recent arrival and providing contact information for an administrator, according to the correspondence provided by Silverado. Not receiving a response, the administrator called again three days later and was told “we don’t need to do anything further at this time,” according to a Silverado spokesman.

The surgeon recovered, but Silverado saw the plague. To date, 90 residents and staff have been stricken with the virus and 13 have died, including Bruner-Ringo. A district spokesman said there was an “ongoing investigation” on the outbreak.

Times writer staff Victoria Kim in Seoul contributed to this report.